Work conditions, musculoskeletal disorders and productivity of dentists in public dental care in Sweden : Are dentists working smarter instead of harder?

Introduction: During the last 20 years, Sweden and other countries have been adjusting their models of welfare to a changed economic environment. Rationalization, influenced by New Public Management, has been implemented in public dentistry in order to improve efficiency and to streamline activities. This has involved transferring some of dentists’ tasks to dental hygienists and dental nurses. The goal is to achieve a more efficient mix of skills and more interaction between professional groups, in order to utilize all skills better in a more efficient work organization. Organizational changes may have an effect on the work environment both with regard to physical and to psychosocial work conditions and affect health and well-being. In many cases these changes have a profound negative effect on musculoskeletal and mental health, and corresponding risk factors, by reducing the number of natural breaks and thus reducing the efficacy of targeted ergonomic interventions. Dentists in Jönköping County in Sweden perceive high precision demands and poor working postures in their work. The five studies in this thesis describe organizational changes and analyse the risk of illness among dentists in the public sector in Jönköping County. Aim: The main aim is to study dentists’ physical and psychosocial work conditions and investigate associations with musculoskeletal disorders, work ability and sick leave during a period of extensive rationalizations; secondly, to assess the risk of illness as a basis for recommending preventive measures. Methods: The present thesis was designed with four cross-sectional studies (Paper I-IV) and one prospective longitudinal study (Paper V). In Paper I, a questionnaire concerning physical and psychosocial work conditions and health was sent out to all employees working in public dental care in Jönköping County in Sweden. To obtain more information on the difficult physical work situation for dentists (Paper I), an observation study with Portable Ergonomic Observation (Paper II) and an sEMG study (Paper III) was then conducted. Paper IV deals with psychosocial issues (using the same survey as in Paper I) and questions in the Eysenk Personality Questionnaire (EPQ) and the Marlowe-Crown scale SD (MCSD), to analyse their impact on perceived physical load. In Paper V, data about physical and psychosocial conditions and health from a survey, as well as production data (number of adult treatments per year per dentist) from computerized patient records (T4), are analysed with regard to changes and associations during a period of extensive rationalizations (2003 – 2008). Results: In Paper I, dentists reported the poorest physical work conditions of all occupational groups and high prevalence of musculoskeletal disorders. However, relatively low intensity of pain was reported and only a small proportion thought that work was affected. Paper II and Paper III confirmed that dentists’ work is physically demanding, with sitting postures and head bent forward, as well as prolonged low muscle loading. Paper IV shows that physical load is mainly influenced by psychosocial demands and to some extent by loss of work control. The results in Paper V show that during the period of extensive rationalizations between 2003 and 2008, dentists perceive improved precision demands and fewer uncomfortable work postures, but still a high level of physical load. The number of adults treated per dentist also improved, but there was a slight deterioration in work control and leadership. Conclusions: The results in this thesis show a consistent picture of high perceived physical load due to high precision demands and uncomfortable work postures, supported by observation of body movements (Portable Ergonomic Observation) and sEMG signs during psychosocially demanding circumstances. The rationalizations implemented in Jönköping County during the period 2003-2008 have not resulted in a deterioration of the physical environment, in spite of the fact that dentists produce more treatments of adult patients than before. This result may indicate that rationalizations do not always lead to increased health risks; it depends how they are implemented. Dentists may have changed the way they work for the better, and due to task delegation and SMS reminders a smoother patient flow has probably resulting in a reduction of workload and perceived stress regarding financial loss

Relation between perceived and measured workload obtained by long-term inclinometry among dentists

Dentists reported high perceived physical work conditions. Working postures and movements of the head and upper extremities during dental work were registered with inclinometry measurements during four hours. The aim was to clarify the relationship between measured working postures/movements and perceived physical work conditions. Dentists worked with elevated arms and a rather steep forward inclination of the head. Correlations (r = -0.52 to -0.66) between inclination velocity and perceived workload on VAS scales were found, but there were only weak correlations between observed working postures. The different tasks involved in dental work provide limited variation in work movements and postures, measured by inclinometry. By alternating between sitting and standing, it might be possible to achieve variation in physical workload during dental work. (c) 2008 Elsevier Ltd. All rights reserved

PR-team som modell för samordnad rehabiliteringsutredning på vårdcentraler i Jönköpings län: Arbetsrapport

Rapporten presenterar och diskuterar resultatet av en studie omkring en regionalt i Jönköpings län framtagen modell för rehabiliteringsutredning i primärvården – PR-team. Studien bygger på tre olika material och har genomförts som tre separata delstudier. Resultaten för delstudierna redovisas i rapporten var för sig. Den första delstudien bygger på material från ett register över samtliga patienter i primärvården i Jönköpings län som har en sjukskrivning som överstiger 28 dagar. Resultat från delstudien visar att en högre andel män genomgår PR-team vid privata vårdcentraler jämfört med kvinnor och att PR-teamutredningar vid offentliga vårdcentraler i en tredjedel av fallen genomfördes under de första 90 dagarna av sjukskrivningsperioden. Vidare noterades att psykisk ohälsa angavs oftare för kvinnor än för män samt att nästan dubbelt så många kvinnor som män avslutades mot arbete eller studier. Den andra delstudien bygger på observationer av genomförda möten i rehabiliteringsteamet där den sammanvägda bedömningen av rehabiliteringsutredningen diskuteras och dokument­eras. I delstudien ingår även intervjuer med mötesdeltagare i så kallade PR-teammöten. Resultatet visar att ett PR-teammöte utgörs av flera delar och att en relativt stor del av mötestiden handlar om hur dokumentationen ska ske och hur olika tolkningar ska göras för att kunna fylla i blanketten på ett korrekt sätt. Det märktes stor skillnad mellan teamen vilket sannolikt berodde på respektive teams vana att arbeta enligt modellen för PR-team samt möjligen en påverkan av att observeras och spelas in. Den tredje delstudien är en analys av dokumentationen från 177 rehabiliteringsutredningar. Analysen visar att dokumentationen utgör en textgenre som nästan helt saknar uttalade subjekt. Det gäller både patienten som texten handlar om och den/de personer som gör bedöm­ningen. I den tematiska analysen framstår smärtproblematik som den främsta anledningen till att en teamutredning genomförs. Tre fjärdedelar av utredningarna handlade om kvinnor. Lång sjukskrivningshistoria, låg utbildning och migrationshistoria framstod som särskilda sårbarhetsfaktorer där såväl att patientens framtidsbild som att teamets bedömning pekade mot ringa förutsättningar för återgång till arbete

Workplace health in dental care – a salutogenic approach

Objective The purpose was to explore self-reported psychosocial health and work environments among different dental occupations and workplaces from a salutogenic perspective. A further purpose was to analyse possible associations between three salutogenic measurements: The Sense of Coherence questionnaire (SOC), the Salutogenic Health Indicator Scale (SHIS) and the Work Experience Measurement Scale (WEMS). Methods Employees in the Public Dental Service in a Swedish county council (n = 486) were invited to respond to a self-reported web survey including demographics, work-related factors, the SOC, the SHIS and the WEMS. Results This study showed positive associations between employee characteristics and self-reported overall psychosocial health as well as experienced work environment. Autonomy was reported more among men than women (P < 0.000) and to a higher degree by dentists and dental hygienists than dental nurses (P < 0.000). Meaningfulness, happiness, job satisfaction, autonomy and positive to reorganization were reported by personnels aged less than 40 years (P ≤ 0.047). Clinical coordinators reported significant better health (SOC, SHIS) and experienced more autonomy, better management and more positive to reorganization than other dental professions. Dental hygienists and nurses experienced less time pressure than dentists (P ≤ 0.007). Better health and positive work experiences were also seen in smaller clinics (P ≤ 0.29). Conclusion Dental professionals reported a high degree of overall psychosocial health as well as a positive work experience. Some variations could be seen between employee characteristics such as gender, years in dental care, professionals, managing position and workplace size. Identify resources and processes at each workplace are important and should be included in the employee's/employers dialogue

Good adherence to adjuvant endocrine therapy in early breast cancer : a population-based study based on the Swedish prescribed Drug Register

Introduction: Adjuvant endocrine therapy improves recurrence-free and overall survival in primary breast cancer. However, not all patients complete their planned treatment, mostly because of side-effects. The aim of this study was to examine the adherence to adjuvant endocrine therapy in a cohort of primary breast cancer patients in Region Jonkoping County, Sweden, after 3 and 5 years. Material and methods: The Swedish Breast Cancer Register was used to identify patients diagnosed with hormone receptor positive breast cancer in Region Jonkoping County between 2009 and 2012. Adherence was evaluated based on data from the Swedish Prescribed Drug Register, and Medication Possession Ratio (MPR), defined as the days' supply of medication during the period from the first dispensing till the last dispensing in the time period (3 and 5 years), divided by number of days. Adherence was defined as MPR >= 80%. Regression analyses were used to identify subgroups associated with adherence; age, type of endocrine treatment, additional adjuvant therapy, and hospital responsible for the follow-up (Eksjo, Jonkoping, and Varnamo). Results: We identified 634 patients who were recommended adjuvant endocrine therapy and to be able to estimate adherence after 3 and 5 years, 488 patients were included in the analysis. After 3 years of treatment, 91.2% of the patients (95% confidence interval (0) 88.7-93.6; n = 445), were found to be adherent. The corresponding figure for the 271 patients who had completed 5 years of treatment was 91.5% (95% CI 88.2-94.8; n=248). No subgroups (age, endocrine therapy, radio/chemotherapy, or hospital) were significantly associated with adherence in the multiple logistic regression analysis. Discussion: This study shows substantially higher adherence to adjuvant endocrine therapy than previously reported. Reasons for this could be differences in routines for therapy information and follow-up, but this needs to be further investigated

Former, förutsättningar och mål för anhörigstöd från anhörig- konsulenters och bistånds- handläggares perspektiv : Resultat från en webbaserad enkät i Jönköpings län och Stockholms län

Den här rapporten är en resa genom anhörigkonsulenters och biståndshandläggares erfarenheter, uppfattningar och förutsättningar för att bedriva anhörigstöd och vilka former av stöd som erbjuds anhöriga. Studien baseras på en webbenkät utskickad till anhörigkonsulenter och biståndshandläggare i Jönköpings län och Stockholms län och vill bidra till en fördjupad kunskap och förståelse för den komplexitet som yrkesrollerna hanterar i sitt dagliga arbete med anhörigstöd. Få studier har hittills gjorts ur det här perspektivet. Att sätta fokus på anhörigkonsulenterna är givet, men biståndshandläggarna möter också många anhöriga i sin yrkesutövning. Tillsammans ger de oss en bredare bild av de förutsättningar man har för att bedriva arbetet med anhörigstöd, vilka stödformer man erbjuder och vilka arbetsformer man använt under covid-19-pandemin. Vi får också en bild av i vilken utsträckning man når de anhöriga och i vilken omfattning man samarbetar med andra aktörer kring anhörigstöd. I studien har vi också ställt frågorom synen på vad socialtjänstens anhörigstöd kan och bör leda till. Resultaten i studien är många och ur dem har vi identifierat fem utvecklingsområden som synliggör möjliga riktningar för kommunerna i arbetet med att utveckla anhörigstödet. På så sätt önskar vi bidra till att stärka det viktiga arbete som anhörigkonsulenter och biståndshandläggare gör dagligen för att underlätta vardagen för alla anhöriga de möter

Prosthetic and orthotic students’ attitudes toward addressing sexual health in their future profession

Background: Prosthetists and orthotists have a responsibility to direct treatment toward enabling their clients to perform desired activities and to facilitate participation of their clients in all areas of life. This may include provision of assistive technologies to help clients meet goals related to participation in sexual activities. To help prosthetic and orthotic students develop competencies in dealing with the sexual health of their future clients, it is necessary to generate knowledge of their own perceived competence and capacity. Objectives: To explore prosthetic and orthotic students’ attitudes and competence toward working with sexual health and to evaluate reliability and validity of the Students’ Attitudes Towards Addressing Sexual Health questionnaire. Study design: Cross-sectional study. Methods: Students enrolled in all three years of an undergraduate prosthetic and orthotic program were requested to complete the Students’ Attitudes Towards Addressing Sexual Health questionnaire (n = 65). Reliability and validity were evaluated using the content validity index and Cronbach’s alpha. Results: Students felt unprepared to talk about sexual health with future clients and thought that they would be embarrassed if they raised the issue. No differences were identified between students enrolled in each of the three years of the program and few differences were observed between male and female students. The content validity index values were low but improved as the students’ level of education increased. Internal consistency of the questionnaire was acceptable (α = 0.86). Conclusion: Prosthetic and orthotic students are unprepared to address sexual health issues with their future clients. There is a need to provide students with training related to sexual health issues. Clinical relevance: This study indicates the need for additional education of prosthetic and orthotic students in issues related to sexual health and how to address sexual health issues with clients. Results can be used to develop training programs for students and will serve to improve the sexual health of individuals who receive prosthetic and orthotic services